Readmissions May be Triggered by 'Post-Hospital Syndrome'

For readmitted patients whose index admission was for treatment of heart failure, pneumonia, or chronic obstructive pulmonary disease, the reason for readmission was not the same as the reason for their first admission for 63%, 71% and 64% of the time, respectively, he wrote.But why, Krumholz asked. "How might the post-hospital syndrome emerge?"

Substantial stress during the experience of being a patient, he suggested.

"During hospitalization, patients are commonly deprived of sleep, experience disruption of normal circadian rhythms, are nourished poorly, have pain and discomfort, confront a baffling array of mentally challenging situations, receive medications that can alter cognition and physical function and become deconditioned by bed rest or inactivity," he wrote.

"Each of these perturbations can adversely affect health and contribute to substantial impairments during the early recovery period, an inability to fend off disease, and susceptibility to mental error."

Krumholz stresses that it's important for hospital transition teams to "ensure that the condition for which a patient was initially admitted is successfully treated," but that teams also need to focus on the early recovery period, during which discharged patients are most vulnerable.

He has given readmission prevention a lot of thought. His group has been contracted with the Centers for Medicare & Medicaid Services to examine certain algorithms and risk adjustments in the 30-day readmission penalty provisions of the Patient Protection and Affordable Care Act.

4 comments on "Readmissions May be Triggered by 'Post-Hospital Syndrome'"

Mary Mammarella (1/18/2013 at 12:31 PM)
This reminded me of an article I read some years ago about physicians who treated people who had been tortured and were trying to recover. I am NOT accusing anyone of torture, but rather suggesting there might be something to learn from those physicians. When you look at the items sited like sleep deprivation, nutrition, pain, etc., it is hard not to connect the patient's reaction to hospitalization to the reactions of released prisoners or victims of torture. Thanks for the article.

Sharon Del Favero (1/16/2013 at 1:18 PM)
A very good argument for a holistic approach to patient care which currently contradicts the "focus only on the admitting diagnosis". While methods of reimbursement see this focus as less costly I would challenge is it really in the big picture? each disease state impacts another if present within the same patient..... does it not?

debra reynolds (1/16/2013 at 11:37 AM)
Sleep deprivation, and feeling alone and out of control of your circumstances can be scary for patients. Healing happens when a patient is at at peace. Explain to the patients in their language and their pace the procedures, lag-times etc. Use volunteers to keep them company in their rooms, if they want one. A little courtesy can go a long way towards recovery.